BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

© 2015, Springer-Verlag Berlin Heidelberg.Genetic studies have identified single nucleotide polymorphisms associated with the risk of prostate cancer. It remains unclear whether such genetic variants are associated with disease aggressiveness. The NCI-SPORE Genetics Working Group retrospectively collected clinicopathologic information and genotype data for 36 SNPs which at the time had been validated to be associated with PC risk from 25,674 cases with PC. Cases were grouped according to race, Gleason score and aggressiveness. Statistical analyses were used to compare the frequency (...) of the SNPs between different disease cohorts. After adjusting for multiple testing, only PC-risk SNP rs2735839 was significantly and inversely associated with aggressive and high-grade disease in European men. Similar associations with aggressive and high-grade disease were documented in African-American subjects. The G allele of rs2735839 was associated with disease aggressiveness even at low PSA levels in both European and African-American men. Our results provide further support that a PC-risk SNP rs2735839 near the KLK3 gene on chromosome 19q13 may be associated with aggressive and high-grade PC. Future prospectively designed, case-case GWAS are needed to identify additional SNPs associated with PC aggressiveness. (shrink)

Aristotle and the sea battle, by G. E. M. Anscombe.--Aristotle's different possibilities, by K. J. J. Hintikka.--On Aristotle's square of opposition, by M. Thompson.--Categories in Aristotle and in Kant, by J. C. Wilson.--Aristotle's Categories, chapters I-V: translation and notes, by J. L. Ackrill.--Aristotle's theory of categories, by J. M. E. Moravcsik.--Essence and accident, by I. M. Copi.--Tithenai ta phainomena, by G. E. L. Owen.--Matter and predication in Aristotle, by J. Owens.--Problems in Metaphysics Z, chapter 13, by M. J. Woods.--The meaning (...) of agathon in the Ethics of Aristotle, by H. A. Prichard.--Agathon and eudaimonia in the Ethics of Aristotle, by J. L. Austin.--The final good in Aristotle's Ethics, by W. F. R. Hardie.--Aristotle on pleasure, by J. O. Urmson.--Bibliography (p. 335-341). (shrink)

At the turn of the century Idealism was perhaps the leading school of philosophy in the English-speaking world. By the 1960s the situation was very different. There had occurred during the previous two generations what has been described as 'a revolution in philosophy', one consequence of which had been the almost total eclipse of Idealism. Originally published in 1962, this book is a critical study of certain aspects of the work of four Idealist philosophers: F. H. Bradley, T. H. Green, (...) Bernard Bosanquet and Josiah Royce. It deals mainly with their social philosophy, but some consideration is also given to their metaphysics. It is the thesis of this book that there is a valid and significant form of Idealism to be found in the work of these philosophers, but that they did not succeed in developing it fully and consistently. (shrink)

Thirty-three physicians, bioethicists, and medical economists from ten different countries met at Lawrence University, Appleton, Wisconsin, to create The Appleton Consensus: International Guidelines for Decisions to Forego Medical Treatment. The guidelines deal with four specific decision-making circumstances: 1. Five guidelines were created for decisions involving competent patients or patients who have executed an advance directive before becoming incompetent, and those guidelines fell into three categories. 2. Thirteen guidelines were created for decisions involving patients who were once competent, but are not (...) now competent, who have not executed an advance directive. 3. Seven guidelines were created for decisions involving patients who are not now and never have been competent, for whom 'no substituted judgement' can be rendered. 4. Eleven guidelines were created for decisions involving the scarcity of medical resources, which exists in all communities. Five concepts were identified as being critical in the establishment of priorities, given the reality of scarce health resources (1). The term 'physician' is used in the American sense, synonymous with 'medical practitioner'. (shrink)

Philosophical discussion tends to converge on the view that narratives are at the center of the emotion of grief. In this article, I expand on this kind of view. On the one hand, I argue that key strands of phenomenological and neuroscientific studies suggest that grief consists in a complex emotional process of disconfirmation-and-updating of the narrative self-model. By heuristically drawing on an analogy between binocular rivalry and grief, I show that certain salient aspects of the phenomenology of grief, such (...) as self-alienation and ambiguity, are straightforwardly reflected by this account. On the other hand, I argue that this hierarchical approach has the resources to: (i) show that both narratable and unnarratable experiences of personal loss are both instances of grief; and (ii) differentiate between narratable and unnarratable experiences of grief, without compromising the view that self-constituting narratives are at the center of the phenomenon. (shrink)

Divided-mind approaches to the conflict involved in self-control are pervasive. According to an influential version of the divided-mind approach, self-control conflict is a dispute between affective reactions and “cold” cognitive processes. I argue that divided-mind approaches are based on problematic bipartite architectural assumptions. Thus views that understand self-control as “control _of_ the self” might be better suited to account for self-control. I subsequently aim to expand on this kind of view. I suggest that self-control conflict involves a rivalry between narrative (...) self-models aimed at reducing error, analogous to model rivalry in binocular rivalry paradigms. This approach straightforwardly accounts for the sense of conflict that is characteristic of self-control within a unified-mind approach, and among its other explanatory advantages, it directly aligns with current views that account for addiction in terms of maladaptive self-representational processes. (shrink)

This unique publication outlines the development of legal theory from pre-Roman times to the twentieth century. It aims to relate the evolution of legal theory to parallel developments in political history, and accordingly offers the reader an account of relevant contemporaneous political, religious, and economic events. Each chapter commences with a general historical background for the relevant period, and discusses how political events and political and legal theory are both related to one another and occasionally influence one another.No other English (...) publication aims to anchor legal theory to contemporary general history in this way, shunning the more conventional approach to legal theory via the study of 'traditions' or 'schools', and it is hoped that this study will provide a much-needed basic text for students of jurisprudence, legal theory and politics. (shrink)

Late Babylonian astronomical texts contain records of the stationary points of the outer planets using three different notational formats: Type S where the position is given relative to a Normal Star and whether it is an eastern or western station is noted, Type I which is similar to Type S except that the Normal Star is replaced by a reference to a zodiacal sign, and Type Z the position is given by reference to a zodiacal sign, but no indication of (...) whether the station is an eastern or western station is included. In these records, the date of the station is sometimes preceded by the terms in and/or EN. We have created a database of station records in order to determine whether there was any pattern in the use of these notation types over time or an association with any bias in the station date or the type of text the station was recorded in. Predictive texts, which include Almanacs and Normal Star Almanacs, almost always use Type Z notation, while the Diaries, compilations, and Goal-Year Texts use all three types. Type Z records almost never include in or EN, while other types seem to include these interchangeably. When compared with modern computed station dates, the records show bias toward earlier dates, suggesting that the Babylonians were observing dates when the planets appeared to stop moving rather than the true station. Overlapping reports, where a station on the same date was recorded in two or more texts, suggest that predicted station dates were used to guide observations, and that the planet’s position on the predicted stationary date was the true point of the observation rather than the specific date of the stationary point. (shrink)

The foreskin in small boys causes much anxiety in our society. It develops during the second half of gestation, and in premature infants may appear relatively deficient. By term, however, it has grown and protruded to well beyond the glans penis. The inner layer of the foreskin is densely adherent to the surface of the glans and cannot be retracted until it is fully separated, which occurs during the first few years of life. Prior to that time the distal opening (...) of the foreskin is narrow, but because of its adherence there is no significant pocket under the skin to allow accumulation of urine or debris. Later in childhood, after the foreskin is fully separated, urine and dirt can accumulate between the foreskin and the glans, leading to infection and inflammation . With recurrent balanitis, and/or tearing of the delicate foreskin, phimosis or scarring may constrict the distal foreskin.Circumcision has a long history in ancient societies of the Middle East, and is likely to have arisen as an early public health measure for preventing recurrent balanitis, caused by sand accumulating under the foreskin. Circumcision is a major part of the ritual for such religions as Judaism, Christianity, and Islam, and it is probably no accident that all of these arose in the Middle East. By contrast, in religions arising outside the arid Middle East , there is no ritual circumcision. In aboriginal society in Australia, circumcision is practised also.The importance of preventing recurrent balanitis and secondary phimosis in arid, sandy regions was confirmed by the Australian army medical corps in two world wars. During both wars, Australian soldiers were stationed in North Africa and the Middle East, and the incidence of recurrent balanitis caused by sand under the foreskin reached “epidemic” proportions, leading to large numbers …. (shrink)

Summary Evidence for the transmission of Babylonian astronomy into the Greco-Roman world is well attested in the form of observations, numerical parameters and astronomical tables. This paper investigates the reception of Babylonian astronomy in the Greco-Roman world and in particular the transmission, transformation and exploitation of the layout of texts and other visual information. Two examples illustrate this process: the use of Babylonian lunar eclipse records by Greek astronomers and the adaptation of Babylonian methods of eclipse prediction in the Antikythera (...) Mechanism. (shrink)

Whether the law should permit individuals to opt out of accepted death standards is a question that must be faced and clarifiedWhile media coverage of the Terri Schiavo case in Florida has recently refocused public attention on end of life decision making, another end of life tragedy in Utah has raised equally challenging—and possibly more fundamental—questions about the roles of physicians and families in matters of death. The patient at the centre of this case was Jesse Koochin, a six year (...) old boy suffering from “inoperable and incurable” brain cancer. He had been undergoing care at Primary Children’s Medical Center in Salt Lake City since September 15, 2004 when “his tumor pushed his brain stem down through the skull”.1 Subsequently, two physicians independently determined that the child was “brain dead” and informed his parents that they would order life support removed within twenty four hours. Steve and Gayle Koochin overtly rejected the hospital’s definition of death. The couple, relying on traditional notions of cardiopulmonary death, obtained a restraining order to keep Jesse on a ventilator and ultimately removed the brain dead child from the hospital. The ongoing case raises the complex question of whether patients’ families should be permitted to opt out of widely accepted definitions of death in favour of their own standards.The definition of death has evolved rapidly in the United States over the past thirty five years. Until the middle of the twentieth century, the medical community, the legal system, and an overwhelming majority of the public understood death to …. (shrink)

There are two passages in which the poet introduces a full moon to accentuate a particular aspect of a scene in his narrative; 1.1228–33 and 4.166–71. I shall concentrate on the second. Commentators have contributed various suggestions but failed to understand the specific erotic-nuptial connotation of the full moon. The same applies to the more specialized contributions of Drogemiiller and Rose. I shall first present the evidence for the nuptial associations of the full moon, then apply this idea to the (...) Apollonian passages, especially 4.166–71, and finally add a remark about the special effect obtained by Apollonius here in relation to an Homeric passage. (shrink)

In Poetics chapter 9, Aristotle famously claims that poetry is more philosophical than history. What does this mean? I argue that he is talking about the metaphysics of events. Poets seek causal coherence among the events in their stories. Historians must report what happened whether or not the events of history exhibit causal coherence. This makes the poet's job more philosophical than the historian's, for the poet is seeking a unified plot -- an action-type -- that serves as the backbone (...) of the story he is trying to tell. The poet's final script is a token of an Aristotelian universal, the universal being an action-type that could have been fleshed out in many different ways, although with similar characters. Hence, the poet shows us what he thinks it is likely or necessary for agents of different types to do in the circumstances that confront them. Aristotelian mimesis, on this account, is the poetic representation of "one action," that is, of one action-type. (shrink)

Without mass media, openness and accountability are impossible in contemporary democracies. Nevertheless, mass media can hinder political transparency as well as help it. Politicians and political operatives can simulate the political virtues of transparency through rhetorical and media manipulation. Television tends to convert coverage of law and politics into forms of entertainment for mass consumption, and television serves as fertile ground for a self‐proliferating culture of scandal. Given the limited time available for broadcast and the limited attention of audiences, stories (...) about political strategy, political infighting, political scandal and the private lives of politicians tend to crowd out less entertaining stories about substantive policy questions. Political life begins to conform increasingly to the image of politics portrayed on television. Through a quasi‐Darwinian process, media events, scandals, and other forms of politics‐as‐entertainment eventually dominate and weed out other forms of political information and public discussion, transforming the very meaning of public discourse. In this way the goals of political transparency can be defeated by what appear to be its central mechanisms: proliferating information, holding political officials accountable for their actions, and uncovering secrets. (shrink)

El presente trabajo resume y comenta algunas de las aportaciones que nos han parecido más relevantes realizadas en los últimos años en torno a la obra filosófica de J. Ortega y Gasset. Desde la aparición del libro de P. Cerezo Galán La voluntad de aventura en 1983, el interés por el problema de Ortega ha experimentado un auge muy significativo y creciente en España, del que son muestra los estudios de Javier San Martín, Mª Carmen Paredes, Fco J. Martín, Máximo (...) Martín Serrano y Jaime de Salas. Nuestro trabajo, tras una exposición resumida de estas interpretaciones, intenta una síntesis conciliadora que creemos sugerida por los propios textos del filósofo. (shrink)

Summary Late Babylonian astronomical texts contain frequent measurements of the positions of the Moon and planets. These measurements include distances of the Moon or a planet from a reference star and measurements of the position of celestial bodies within a sign of the zodiac. In this paper, I investigate the relationship between these two measurement systems and propose a new understanding of the concepts of celestial longitude and latitude in Babylonian astronomy. I argue that the Babylonians did not define latitude (...) using the ecliptic but instead considered the Moon and each planet to move up or down within its own band as it travelled around the zodiac. (shrink)

Consider the problem of allocating a scarce resource to people. A fair decision procedure is one where each person has an equal chance of receiving the resource. An unfair decision procedure is one where the chances are not equal. Normally we think that, in an unfair decision procedure, that the correct way to redress the injustice is by rerunning the allocation using a fair decision procedure. In this paper, I show that this actually creates an overall bias favouring one person, (...) and solutions to this problem are counterintuitive, in that they typically involve introducing additional unfair elements into the situation. (shrink)